What is social anxiety?
Social anxiety is a strong, lasting fear of being judged, embarrassed or rejected by other people, which leads many people to avoid or dread everyday social situations. The National Institute of Mental Health gives examples that will be familiar to many readers: meeting new people, asking for help, speaking up in a meeting, eating in front of others, or even talking to a cashier in a store.
It is more than shyness. NIMH says people with social anxiety disorder may worry about a social event for weeks before it happens, and afterward pick over their performance for flaws. Many end up avoiding the places and events that cause distress. Avoidance feels like relief in the short term, but NIMH notes that the anxiety is likely to remain without treatment.
Why it can feel harder in a small town
Social anxiety turns on the fear of being seen and judged. In a small community you are seen a great deal, by the same people, in every part of life. A few things make that weigh more heavily here:
- Overlapping roles: the person you stumbled over your words with at the town meeting is also your neighbor, your customer and your child's teacher.
- Long memories: in a place where families go back generations, it can feel as if an awkward moment will be remembered forever.
- Fewer places to blend in: there is one main grocery, one post office, a handful of churches and restaurants, so avoidance quickly narrows your options.
- Community events as obligations: horse shows, festivals, church suppers and fundraisers are a big part of local life, and skipping them can be noticed.
- Newcomers' pressure: people who have moved to the Thermal Belt may feel they are being sized up while they try to make friends.
The other side of small-town life
Small places can also be forgiving. People who know you over time tend to judge you on many encounters rather than one. Part of what therapy for social anxiety often involves is testing the predictions anxiety makes, such as that everyone noticed, or that they will think less of you, and seeing how often they turn out to be wrong.
How social anxiety can feel
NIMH lists signs that people with social anxiety commonly describe when they have to perform or be around others:
- Blushing, sweating, trembling or a racing heart.
- Feeling the mind go blank, or feeling sick to the stomach.
- A rigid posture or a very soft voice.
- Finding it hard to make eye contact or talk with people, even when you want to.
- Feeling self-conscious and expecting to be judged negatively.
- Expecting the worst possible outcome from a social slip.
How common is it, and why do people wait?
NIMH estimates that 7.1% of U.S. adults had social anxiety disorder in the past year and that about 12.1% experience it at some point in their lives. It usually begins in childhood or adolescence, so many adults have lived with it so long that it feels like part of their personality.
NIMH also notes that people with social anxiety disorder are less likely to seek help, and that providers often first identify it while treating something else. That makes sense: the very act of calling a stranger, sitting in a waiting room or explaining yourself can trigger the fear. If that is what is holding you back, it may help to know you can start by sending a short message rather than calling. Our pages on what therapists can and cannot share and seeing a counselor outside your own town address the privacy side.
What treatment usually involves
NIMH says treatment for social anxiety disorder typically involves psychotherapy, medication or both. It describes cognitive behavioral therapy as a research-supported approach that teaches different ways of thinking about and reacting to social situations and can include practicing social skills. It describes exposure therapy as progressively facing feared situations, often alongside relaxation exercises, and mentions acceptance and commitment therapy as another option with growing research support.
NIMH lists antidepressants such as SSRIs and SNRIs among medications that may be prescribed, along with others; decisions about medication belong with your doctor. NIMH also notes that some people find support groups helpful, because hearing honest feedback from others with the same fear can show that the predicted judgment is often not real.
For a fuller picture of the counseling side, see how counseling helps anxiety.
Reaching out without the spotlight
Laura Bass is a psychotherapist who works with adults, and anxiety is among the concerns she sees. She has a part-time office at The Healing Cottage in Columbus. If a phone call feels like too much, the contact page lets you write a short message instead; you can also call 704-706-3264. Ask which days she is in Columbus.
If anxiety ever turns into a crisis, call or text 988, or call Vaya Health at 1-800-849-6127. If anyone is in immediate danger, call 911.
Common questions
Is social anxiety just shyness?
No. Shyness is a temperament many people are comfortable with. NIMH describes social anxiety disorder as fear of judgment that feels uncontrollable, lasts at least six months and interferes with work, relationships or daily life, often with weeks of dread beforehand and avoidance of situations. If shyness is costing you things you want, it is worth talking it over with someone.
What if I know the therapist or other clients socially?
In a small area this happens. A therapist should tell you if an existing relationship means they cannot see you, and should never discuss one client with another. If you discover a connection later, raise it. Many people choose a counselor in a neighboring town for this reason; see our page on seeing a counselor outside your own town.
Can I start without making a phone call?
Yes. Many people with social anxiety find a written message easier as a first step. A short note with your name, how to reach you and a line about what you would like help with is enough. You do not need to explain everything at once, and it is fine to say that calling is hard for you.
Will avoiding situations make it go away?
Avoidance usually brings short-term relief, which is why it is so tempting. NIMH notes, though, that the anxiety is likely to remain without treatment, and avoidance can slowly shrink your life. Therapy often works by helping you return to avoided situations gradually, at a pace you agree to, with support.